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Medicines and choices. Health policy and individual decision-making

Wirtz, Veronika; (2004) Medicines and choices. Health policy and individual decision-making. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Background and aims: Decisions about choices of medicines are made concerning a population or an individual health care user. Key aims of the thesis were first, to investigate authoritative decision-making in the British National Health Service (NHS) about the access to medicines; second, to investigate the views of health care professionals (HCPs) and patients on making choices about medicine treatment within the medical consultation, including the use of informed consent for medicines; and finally, to seek similarities and differences between the factors found to contribute to each type of decision-making about choices investigated before. Methods: Health policy decision-making was investigated by using a document analysis and in-depth interviews with a range of policy-makers and stakeholders. Individual decision-making was explored by conducting in-depth interviews with doctors, nurses and hospital in- and outpatients from various medical specialities. Informed consent was chosen as an applied model of decision-making where the patient makes a choice. Results: Cost containment and generating politically and legally defensible decisions were strong influences on the process and the outcomes of health policy decisionmaking. Although data about benefit, safety and cost considerations were used as the main legitimisation for the definition of access criteria, several informal and organisational factors were found to have significant influence on decision-making. The lack of information provision about side effects and treatment alternatives made it impossible for patients to make an informed decision about their medication. Informed consent was not regarded as a model to support patients in making informed decisions. Although doctors described patients as a 'partner' in the decisions, an eliciting and implementation of the patients' preferences and values was largely absent. Conclusions: A more consistent application of a minimum moral standard of patient involvement in prescribing decisions could improve individual decision-making. Health policy decisions could benefit from an awareness of the influence of informal factors on health policy decisions.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Medicines and choices. Health policy and individual decision-making
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest.
Keywords: Social sciences; Health and environmental sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10101219
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